Rodrigo Pedraza, MD, Edward Y Chan, MD, Ray K Chihara, MD, PhD, Leonora M Meisenbach, MSN, APRN, ACNPBC, Min P Kim, MD. Houston Methodist Hospital
Background and Aim: The use of a magnetic sphincter augmentation device (LINX) has been shown to be safe and efficacious for the management of gastroesophageal reflux disease (GERD). The endoluminal functional lumen-imaging probe (EndoFLIP) distensibility index (DI) has been correlated with significant dysphagia after surgery. We want to determine if umbilical tape can better predict the final EndoFLIP distensibility index compared to the LINX sizer.
Methods: From 5/2017 to 2/2018, all patients who underwent LINX placement with EndoFLIP analysis were evaluated. Our technique included the placement of an EndoFLIP to assess EGJ distensibility. An umbilical tape is marked at different sites according to the LINX available sizes. We also used the LINX sizer to measure the EndoFLIP distensibility index (Figure 1). The umbilical tape is placed around the EGJ and is tightened on each size mark while evaluating the EGJ distensibility using the EndoFLIP®. The LINX size is selected based on distensibility values (Figure 1).
Results: A total of 30 patients were evaluated. The patient demographics included a mean age of 54, 83% females, a median ASA of 2, and an average BMI of 30.5. On esophagram, 43% had type III hiatal hernia and 57% had type I hiatal hernia. On manometry, peristalsis was normal on >70% of swallowing episodes for all patients. The mean preoperative DeMeester score was 34. All procedures were performed robotically. The median LINX size was 16 (14-17). Intraoperatively, there were no complications and the average operating time was 3 hours. Thirteen patients had an EndoFLIP assessment using the sizing tool provided by the manufacturer and there was no correlation between the sizing tool EndoFLIP value and the final value after LINX placement. Seventeen patients had umbilical tape used for sizing and there was perfect correlation in 94% of the patients. The mean LOS was 1 day (0-3) and there were no postoperative complications, readmissions, or reoperations. The mean pre-intervention EGJ distensibility index was 2.9 as compared with postoperative 1.5, p<0.0001. The mean preoperative GERD QOL was 24 as compared with postoperative 5.5, p<0.0001.
Conclusions: Our analysis revealed that umbilical tape provides a better predictive final EndoFLIP DI after LINX placement compared to the LINX sizer. Further research is needed to assess whether this approach may potentially avoid placement of an improper size of LINX device.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94251
Program Number: P501
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster